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Hyperinflation Ex 1

What are the three types of Atelectasis? Resorption, Passive, Adhesive
What is Resorption Atelectasis? Obstruction of the bronchus by tumor, mucus, or foreign body
What is Passive Atelectasis? Failure of ability to intermittently stretch alveoli by deep breathing, sighing, or yawning
What is Adhesive Atelectasis? Atelectasis caused by a surfactant deficiency
What are the causes of atelectasis? Cause varies based on the type of atelectasis, but the underlying cause is an inability to open the alveoli
What are the signs/symptoms of atelectasis? Rapid/shallow breathing, increased tactile fremitus, dullness to percussion, fine, late inspiratory crackles, bronchial, or diminished breath sounds
How would a CXR confirm atelectasis? Increased opacities, elevated diaphragm, fissure displacement, mediastinal shift towards the affected side, crowding of ribs on the affected side, compensary hyper-expansion of surrounding lung
What is Incentive Spirometry? Mimics natural sighing, encourages patients to take slow, deep breaths, visual cues monitor patient progress towards the goal
What is the SMI - basic maneuver? Sustained maximal inhalation; a slow, deep inhalation from FRC up to TLC followed by a 5-10 second breath hold
What are the indications for IS? Condition predisposed to atelectasis, upper abdominal or thoracic surgery, COPD patients who will have surgery, presence of atelectasis, restrictive lung defect associated with neuromuscular dysfunction
What are the contraindications for IS? Uncooperative patients, obtunded patients, unconscious patients
What are the hazards associated with IS? Hyperventilation, discomfort, pulmonary barotrauma, exacerbation of bronchospasm, fatigue, hypoxia, ineffective unless supervised or performed as ordered
What is the criteria for IS? Identify goals based on patient ability, baseline assessment, determine pre-op IC to set post-op goal, VC<10ml/kg or IC 1/3 of predicted - consider IPPB
What is the volume oriented IS? Measures volume, during inspiration, as the patient draws air in through the breathing hose bellow rises and indicates volume
What is flow oriented IS? Can be equated with volume by assessing during of inspiration (Flow x Time = Volume)
How would you instruct a patient in the use of IS? Inhale slowly and deeply, hold breath for 5-10 seconds, 30-60 second rest period, repeat 10x per hour
What is the definition of IPPB? Intermittent Positive Airway Pressure
How does IPPB affect MAP physiologically? Increases Mean Airway Pressure
How does IPPB affect Intrathoracic pressure physiologically? Increases Intrathoracic Pressure
How does IPPB affect venous return? Decreases venous return
How does IPPB affect cardiac output? Increased PL causes decreased Cardiac Output
How does IPPB affect ICP? Blood will back up causing increased ICP
What are the goals of IPPB? Provide increased Vt, improve/promote cough, improve distribution of ventilation/reduce atelectasis, deliver meds: improved distribution, improved BS (lung bases), improve oxygenation, favorable PT response
How should a patient be positioned for IPPB? Semi-Fowler's position
What is the initial sensitivity setting for IPPB? -1 to -2 cmH2O
What is the initial pressure setting for IPPB? 10 - 15 cmH2O
What is the initial BPM for IPPB? 6 BPM
What is the initial I:E ratio for IPPB? 1:3 to 1:4
What controls Vt during IPPB? PIP (positive inspiratory pressure)
What controls I-time during IPPB? Flow
What setting is breath triggered during IPPB? Sensitivity
How would you troubleshoot any leaks that occur during IPPB? Device will not cycle off; check patient and machine for leaks
How would you troubleshoot a large negative pressure swing in early inspiration during IPPB? Check sensitivity
How would you troubleshoot a system pressure drop after inspiration during IPPB? Increase flow
What affect can kinked tubing have on IPPB? How would you address this? Can cause device to cycle off prematurely; fix tubing
What affect can an occluded mouthpiece have on IPPB? How would you address this? Cause the device to cycle off prematurely; coach patient on breathing or switch to mask
How would active resistance to inhalation effect IPPB? How would you address it? Cause the device to cycle off prematurely; coach patient on breathing
How are the Bird Mask 7 and the Bennet PR 2 powered? Pneumatically powered
Created by: ashconrad417